Kohala Hospital

All Charges

Charge

Type

Setting

Price

BISACODYL 5 MG PO TAB DR EC

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16

BONE DISEASES AND ARTHROPATHIES WITH MCC

Facility

$12,490.95

Service Code	MSDRG 553
Min. Negotiated Rate	$12,490.95
Max. Negotiated Rate	$12,490.95
Rate for Payer: Hawaii Medical Service Association Commercial	$12,490.95

BONE DISEASES AND ARTHROPATHIES WITHOUT MCC

Facility

$12,396.15

Service Code	MSDRG 554
Min. Negotiated Rate	$12,396.15
Max. Negotiated Rate	$12,396.15
Rate for Payer: Hawaii Medical Service Association Commercial	$12,396.15

BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC

Facility

$25,171.52

Service Code	MSDRG 584
Min. Negotiated Rate	$25,171.52
Max. Negotiated Rate	$25,171.52
Rate for Payer: Hawaii Medical Service Association Commercial	$25,171.52

BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC

Facility

$24,365.66

Service Code	MSDRG 585
Min. Negotiated Rate	$24,365.66
Max. Negotiated Rate	$24,365.66
Rate for Payer: Hawaii Medical Service Association Commercial	$24,365.66

BRIMONIDINE 0.15 % OPHT DROP

Facility

$637.93

Service Code	NDC 61314014405
Hospital Revenue Code	250
Min. Negotiated Rate	$542.24
Max. Negotiated Rate	$618.79
Rate for Payer: Cash Price	$414.65
Rate for Payer: Health Management Network Commercial	$542.24
Rate for Payer: Kaiser Permanente Commercial	$574.14
Rate for Payer: MDX Hawaii PPO	$618.79

BRIMONIDINE 0.15 % OPHT DROP

Facility

$637.93

Service Code	NDC 61314014405
Hospital Revenue Code	250
Min. Negotiated Rate	$318.96
Max. Negotiated Rate	$631.55
Rate for Payer: AlohaCare Medicaid	$318.96
Rate for Payer: AlohaCare Medicare	$574.14
Rate for Payer: Cash Price	$414.65
Rate for Payer: Devoted Health Medicare	$631.55
Rate for Payer: Hawaii Medical Service Association Medicare	$574.14
Rate for Payer: Hawaii Western Management Group Commercial	$606.03
Rate for Payer: Health Management Network Commercial	$542.24
Rate for Payer: Humana Medicare	$574.14
Rate for Payer: Kaiser Permanente Commercial	$574.14
Rate for Payer: Kaiser Permanente Medicaid	$325.34
Rate for Payer: Kaiser Permanente Medicare	$574.14
Rate for Payer: MDX Hawaii PPO	$618.79
Rate for Payer: Ohana Health Plan Medicaid	$574.14
Rate for Payer: Ohana Health Plan Medicare	$574.14
Rate for Payer: UnitedHealthcare Medicaid	$382.76
Rate for Payer: UnitedHealthcare Medicare	$574.14
Rate for Payer: University Health Alliance Commercial	$464.99

BROMFENAC 0.09 % OPHT DROP

Facility

$535.75

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$455.39
Max. Negotiated Rate	$519.68
Rate for Payer: Cash Price	$348.24
Rate for Payer: Health Management Network Commercial	$455.39
Rate for Payer: Kaiser Permanente Commercial	$482.18
Rate for Payer: MDX Hawaii PPO	$519.68

BROMFENAC 0.09 % OPHT DROP

Facility

$535.75

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$267.88
Max. Negotiated Rate	$530.39
Rate for Payer: AlohaCare Medicaid	$267.88
Rate for Payer: AlohaCare Medicare	$482.18
Rate for Payer: Cash Price	$348.24
Rate for Payer: Devoted Health Medicare	$530.39
Rate for Payer: Hawaii Medical Service Association Medicare	$482.18
Rate for Payer: Hawaii Western Management Group Commercial	$508.96
Rate for Payer: Health Management Network Commercial	$455.39
Rate for Payer: Humana Medicare	$482.18
Rate for Payer: Kaiser Permanente Commercial	$482.18
Rate for Payer: Kaiser Permanente Medicaid	$273.23
Rate for Payer: Kaiser Permanente Medicare	$482.18
Rate for Payer: MDX Hawaii PPO	$519.68
Rate for Payer: Ohana Health Plan Medicaid	$482.18
Rate for Payer: Ohana Health Plan Medicare	$482.18
Rate for Payer: UnitedHealthcare Medicare	$482.18
Rate for Payer: University Health Alliance Commercial	$390.51

BROMOCRIPTINE 2.5 MG PO TABLET

Facility

$22.84

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$19.41
Max. Negotiated Rate	$22.15
Rate for Payer: Cash Price	$14.85
Rate for Payer: Cash Price	$13.47
Rate for Payer: Health Management Network Commercial	$19.41
Rate for Payer: Health Management Network Commercial	$17.62
Rate for Payer: Kaiser Permanente Commercial	$20.56
Rate for Payer: Kaiser Permanente Commercial	$18.66
Rate for Payer: MDX Hawaii PPO	$20.11
Rate for Payer: MDX Hawaii PPO	$22.15

BROMOCRIPTINE 2.5 MG PO TABLET

Facility

$20.73

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$10.37
Max. Negotiated Rate	$20.52
Rate for Payer: Kaiser Permanente Commercial	$18.66
Rate for Payer: AlohaCare Medicaid	$10.37
Rate for Payer: AlohaCare Medicaid	$11.42
Rate for Payer: AlohaCare Medicare	$18.66
Rate for Payer: AlohaCare Medicare	$20.56
Rate for Payer: Cash Price	$14.85
Rate for Payer: Cash Price	$13.47
Rate for Payer: Devoted Health Medicare	$20.52
Rate for Payer: Devoted Health Medicare	$22.61
Rate for Payer: Hawaii Medical Service Association Medicare	$20.56
Rate for Payer: Hawaii Medical Service Association Medicare	$18.66
Rate for Payer: Hawaii Western Management Group Commercial	$21.70
Rate for Payer: Hawaii Western Management Group Commercial	$19.69
Rate for Payer: Health Management Network Commercial	$17.62
Rate for Payer: Health Management Network Commercial	$19.41
Rate for Payer: Humana Medicare	$20.56
Rate for Payer: Humana Medicare	$18.66
Rate for Payer: Kaiser Permanente Commercial	$20.56
Rate for Payer: Kaiser Permanente Medicaid	$11.65
Rate for Payer: Kaiser Permanente Medicaid	$10.57
Rate for Payer: Kaiser Permanente Medicare	$20.56
Rate for Payer: Kaiser Permanente Medicare	$18.66
Rate for Payer: MDX Hawaii PPO	$22.15
Rate for Payer: MDX Hawaii PPO	$20.11
Rate for Payer: Ohana Health Plan Medicaid	$18.66
Rate for Payer: Ohana Health Plan Medicaid	$20.56
Rate for Payer: Ohana Health Plan Medicare	$18.66
Rate for Payer: Ohana Health Plan Medicare	$20.56
Rate for Payer: UnitedHealthcare Medicare	$18.66
Rate for Payer: UnitedHealthcare Medicare	$20.56
Rate for Payer: University Health Alliance Commercial	$16.65
Rate for Payer: University Health Alliance Commercial	$15.11

BRONCHITIS AND ASTHMA WITH CC/MCC

Facility

$17,800.20

Service Code	MSDRG 202
Min. Negotiated Rate	$17,800.20
Max. Negotiated Rate	$17,800.20
Rate for Payer: Hawaii Medical Service Association Commercial	$17,800.20

BRONCHITIS AND ASTHMA WITHOUT CC/MCC

Facility

$13,533.84

Service Code	MSDRG 203
Min. Negotiated Rate	$13,533.84
Max. Negotiated Rate	$13,533.84
Rate for Payer: Hawaii Medical Service Association Commercial	$13,533.84

BUDESONIDE 0.5 MG/2 ML INHAL NBSP

Facility

$64.23

Service Code	NDC 00487970101
Hospital Revenue Code	250
Min. Negotiated Rate	$32.12
Max. Negotiated Rate	$63.59
Rate for Payer: AlohaCare Medicaid	$32.12
Rate for Payer: AlohaCare Medicare	$57.81
Rate for Payer: Cash Price	$41.75
Rate for Payer: Devoted Health Medicare	$63.59
Rate for Payer: Hawaii Medical Service Association Medicare	$57.81
Rate for Payer: Hawaii Western Management Group Commercial	$61.02
Rate for Payer: Health Management Network Commercial	$54.60
Rate for Payer: Humana Medicare	$57.81
Rate for Payer: Kaiser Permanente Commercial	$57.81
Rate for Payer: Kaiser Permanente Medicaid	$32.76
Rate for Payer: Kaiser Permanente Medicare	$57.81
Rate for Payer: MDX Hawaii PPO	$62.30
Rate for Payer: Ohana Health Plan Medicaid	$57.81
Rate for Payer: Ohana Health Plan Medicare	$57.81
Rate for Payer: UnitedHealthcare Medicaid	$38.54
Rate for Payer: UnitedHealthcare Medicare	$57.81
Rate for Payer: University Health Alliance Commercial	$46.82

BUDESONIDE 0.5 MG/2 ML INHAL NBSP

Facility

$64.23

Service Code	NDC 00487970101
Hospital Revenue Code	250
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$62.30
Rate for Payer: Cash Price	$41.75
Rate for Payer: Health Management Network Commercial	$54.60
Rate for Payer: Kaiser Permanente Commercial	$57.81
Rate for Payer: MDX Hawaii PPO	$62.30

BUMETANIDE 0.25 MG/ML INJ SOLN

Facility

$18.11

Service Code	HCPCS J1939
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$17.93
Rate for Payer: AlohaCare Medicaid	$9.05
Rate for Payer: AlohaCare Medicaid	$8.34
Rate for Payer: AlohaCare Medicare	$16.30
Rate for Payer: AlohaCare Medicare	$15.01
Rate for Payer: Cash Price	$11.77
Rate for Payer: Cash Price	$10.84
Rate for Payer: Cash Price	$10.84
Rate for Payer: Cash Price	$11.77
Rate for Payer: Devoted Health Medicare	$16.51
Rate for Payer: Devoted Health Medicare	$17.93
Rate for Payer: Hawaii Medical Service Association ABD	$0.61
Rate for Payer: Hawaii Medical Service Association ABD	$0.61
Rate for Payer: Hawaii Medical Service Association Medicare	$16.30
Rate for Payer: Hawaii Medical Service Association Medicare	$15.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.61
Rate for Payer: Hawaii Western Management Group Commercial	$15.85
Rate for Payer: Hawaii Western Management Group Commercial	$17.20
Rate for Payer: Health Management Network Commercial	$15.39
Rate for Payer: Health Management Network Commercial	$14.18
Rate for Payer: Humana Medicare	$16.30
Rate for Payer: Humana Medicare	$15.01
Rate for Payer: Kaiser Permanente Commercial	$16.30
Rate for Payer: Kaiser Permanente Commercial	$15.01
Rate for Payer: Kaiser Permanente Medicaid	$9.24
Rate for Payer: Kaiser Permanente Medicaid	$8.51
Rate for Payer: Kaiser Permanente Medicare	$15.01
Rate for Payer: Kaiser Permanente Medicare	$16.30
Rate for Payer: MDX Hawaii PPO	$17.57
Rate for Payer: MDX Hawaii PPO	$16.18
Rate for Payer: Ohana Health Plan Medicaid	$15.01
Rate for Payer: Ohana Health Plan Medicaid	$16.30
Rate for Payer: Ohana Health Plan Medicare	$15.01
Rate for Payer: Ohana Health Plan Medicare	$16.30
Rate for Payer: UnitedHealthcare Medicaid	$10.01
Rate for Payer: UnitedHealthcare Medicaid	$10.87
Rate for Payer: UnitedHealthcare Medicare	$15.01
Rate for Payer: UnitedHealthcare Medicare	$16.30
Rate for Payer: University Health Alliance Commercial	$13.20
Rate for Payer: University Health Alliance Commercial	$12.16

BUMETANIDE 0.25 MG/ML INJ SOLN

Facility

$18.11

Service Code	HCPCS J1939
Hospital Revenue Code	250
Min. Negotiated Rate	$15.39
Max. Negotiated Rate	$17.57
Rate for Payer: Cash Price	$11.77
Rate for Payer: Cash Price	$10.84
Rate for Payer: Health Management Network Commercial	$15.39
Rate for Payer: Health Management Network Commercial	$14.18
Rate for Payer: Kaiser Permanente Commercial	$15.01
Rate for Payer: Kaiser Permanente Commercial	$16.30
Rate for Payer: MDX Hawaii PPO	$17.57
Rate for Payer: MDX Hawaii PPO	$16.18

BUMETANIDE 0.5 MG PO TABLET

Facility

$13.27

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$13.14
Rate for Payer: AlohaCare Medicaid	$6.63
Rate for Payer: AlohaCare Medicaid	$0.94
Rate for Payer: AlohaCare Medicare	$11.94
Rate for Payer: AlohaCare Medicare	$1.69
Rate for Payer: Cash Price	$1.22
Rate for Payer: Cash Price	$8.63
Rate for Payer: Devoted Health Medicare	$13.14
Rate for Payer: Devoted Health Medicare	$1.86
Rate for Payer: Hawaii Medical Service Association Medicare	$1.69
Rate for Payer: Hawaii Medical Service Association Medicare	$11.94
Rate for Payer: Hawaii Western Management Group Commercial	$1.79
Rate for Payer: Hawaii Western Management Group Commercial	$12.61
Rate for Payer: Health Management Network Commercial	$11.28
Rate for Payer: Health Management Network Commercial	$1.60
Rate for Payer: Humana Medicare	$1.69
Rate for Payer: Humana Medicare	$11.94
Rate for Payer: Kaiser Permanente Commercial	$11.94
Rate for Payer: Kaiser Permanente Commercial	$1.69
Rate for Payer: Kaiser Permanente Medicaid	$0.96
Rate for Payer: Kaiser Permanente Medicaid	$6.77
Rate for Payer: Kaiser Permanente Medicare	$1.69
Rate for Payer: Kaiser Permanente Medicare	$11.94
Rate for Payer: MDX Hawaii PPO	$1.82
Rate for Payer: MDX Hawaii PPO	$12.87
Rate for Payer: Ohana Health Plan Medicaid	$11.94
Rate for Payer: Ohana Health Plan Medicaid	$1.69
Rate for Payer: Ohana Health Plan Medicare	$11.94
Rate for Payer: Ohana Health Plan Medicare	$1.69
Rate for Payer: UnitedHealthcare Medicare	$11.94
Rate for Payer: UnitedHealthcare Medicare	$1.69
Rate for Payer: University Health Alliance Commercial	$1.37
Rate for Payer: University Health Alliance Commercial	$9.67

BUMETANIDE 0.5 MG PO TABLET

Facility

$1.88

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$1.82
Rate for Payer: Cash Price	$1.22
Rate for Payer: Cash Price	$8.63
Rate for Payer: Health Management Network Commercial	$1.60
Rate for Payer: Health Management Network Commercial	$11.28
Rate for Payer: Kaiser Permanente Commercial	$1.69
Rate for Payer: Kaiser Permanente Commercial	$11.94
Rate for Payer: MDX Hawaii PPO	$12.87
Rate for Payer: MDX Hawaii PPO	$1.82

BUMETANIDE 1 MG PO TABLET

Facility

$7.17

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$7.10
Rate for Payer: AlohaCare Medicaid	$3.58
Rate for Payer: AlohaCare Medicare	$6.45
Rate for Payer: Cash Price	$4.66
Rate for Payer: Devoted Health Medicare	$7.10
Rate for Payer: Hawaii Medical Service Association Medicare	$6.45
Rate for Payer: Hawaii Western Management Group Commercial	$6.81
Rate for Payer: Health Management Network Commercial	$6.09
Rate for Payer: Humana Medicare	$6.45
Rate for Payer: Kaiser Permanente Commercial	$6.45
Rate for Payer: Kaiser Permanente Medicaid	$3.66
Rate for Payer: Kaiser Permanente Medicare	$6.45
Rate for Payer: MDX Hawaii PPO	$6.95
Rate for Payer: Ohana Health Plan Medicaid	$6.45
Rate for Payer: Ohana Health Plan Medicare	$6.45
Rate for Payer: UnitedHealthcare Medicare	$6.45
Rate for Payer: University Health Alliance Commercial	$5.23

BUMETANIDE 1 MG PO TABLET

Facility

$7.17

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$6.95
Rate for Payer: Cash Price	$4.66
Rate for Payer: Health Management Network Commercial	$6.09
Rate for Payer: Kaiser Permanente Commercial	$6.45
Rate for Payer: MDX Hawaii PPO	$6.95

BUMETANIDE 2 MG PO TABLET

Facility

$11.18

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$11.07
Rate for Payer: AlohaCare Medicaid	$5.59
Rate for Payer: AlohaCare Medicaid	$4.89
Rate for Payer: AlohaCare Medicaid	$5.76
Rate for Payer: AlohaCare Medicare	$10.38
Rate for Payer: AlohaCare Medicare	$10.06
Rate for Payer: AlohaCare Medicare	$8.80
Rate for Payer: Cash Price	$6.36
Rate for Payer: Cash Price	$7.27
Rate for Payer: Cash Price	$7.49
Rate for Payer: Devoted Health Medicare	$11.41
Rate for Payer: Devoted Health Medicare	$11.07
Rate for Payer: Devoted Health Medicare	$9.68
Rate for Payer: Hawaii Medical Service Association Medicare	$8.80
Rate for Payer: Hawaii Medical Service Association Medicare	$10.06
Rate for Payer: Hawaii Medical Service Association Medicare	$10.38
Rate for Payer: Hawaii Western Management Group Commercial	$9.29
Rate for Payer: Hawaii Western Management Group Commercial	$10.62
Rate for Payer: Hawaii Western Management Group Commercial	$10.95
Rate for Payer: Health Management Network Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$9.80
Rate for Payer: Health Management Network Commercial	$8.31
Rate for Payer: Humana Medicare	$10.38
Rate for Payer: Humana Medicare	$8.80
Rate for Payer: Humana Medicare	$10.06
Rate for Payer: Kaiser Permanente Commercial	$10.38
Rate for Payer: Kaiser Permanente Commercial	$10.06
Rate for Payer: Kaiser Permanente Commercial	$8.80
Rate for Payer: Kaiser Permanente Medicaid	$4.99
Rate for Payer: Kaiser Permanente Medicaid	$5.70
Rate for Payer: Kaiser Permanente Medicaid	$5.88
Rate for Payer: Kaiser Permanente Medicare	$10.06
Rate for Payer: Kaiser Permanente Medicare	$10.38
Rate for Payer: Kaiser Permanente Medicare	$8.80
Rate for Payer: MDX Hawaii PPO	$10.84
Rate for Payer: MDX Hawaii PPO	$11.18
Rate for Payer: MDX Hawaii PPO	$9.49
Rate for Payer: Ohana Health Plan Medicaid	$10.38
Rate for Payer: Ohana Health Plan Medicaid	$10.06
Rate for Payer: Ohana Health Plan Medicaid	$8.80
Rate for Payer: Ohana Health Plan Medicare	$10.06
Rate for Payer: Ohana Health Plan Medicare	$10.38
Rate for Payer: Ohana Health Plan Medicare	$8.80
Rate for Payer: UnitedHealthcare Medicare	$10.06
Rate for Payer: UnitedHealthcare Medicare	$8.80
Rate for Payer: UnitedHealthcare Medicare	$10.38
Rate for Payer: University Health Alliance Commercial	$8.40
Rate for Payer: University Health Alliance Commercial	$8.15
Rate for Payer: University Health Alliance Commercial	$7.13

BUMETANIDE 2 MG PO TABLET

Facility

$11.53

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$11.18
Rate for Payer: Cash Price	$7.49
Rate for Payer: Cash Price	$7.27
Rate for Payer: Cash Price	$6.36
Rate for Payer: Health Management Network Commercial	$8.31
Rate for Payer: Health Management Network Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$9.80
Rate for Payer: Kaiser Permanente Commercial	$8.80
Rate for Payer: Kaiser Permanente Commercial	$10.06
Rate for Payer: Kaiser Permanente Commercial	$10.38
Rate for Payer: MDX Hawaii PPO	$11.18
Rate for Payer: MDX Hawaii PPO	$10.84
Rate for Payer: MDX Hawaii PPO	$9.49

BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN

Facility

$57.96

Service Code	HCPCS J0665
Hospital Revenue Code	250
Min. Negotiated Rate	$49.27
Max. Negotiated Rate	$56.22
Rate for Payer: Cash Price	$37.67
Rate for Payer: Health Management Network Commercial	$49.27
Rate for Payer: Kaiser Permanente Commercial	$52.16
Rate for Payer: MDX Hawaii PPO	$56.22

BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN

Facility

$57.96

Service Code	HCPCS J0665
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$57.38
Rate for Payer: AlohaCare Medicaid	$28.98
Rate for Payer: AlohaCare Medicare	$52.16
Rate for Payer: Cash Price	$37.67
Rate for Payer: Cash Price	$37.67
Rate for Payer: Devoted Health Medicare	$57.38
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Medicare	$52.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$55.06
Rate for Payer: Health Management Network Commercial	$49.27
Rate for Payer: Humana Medicare	$52.16
Rate for Payer: Kaiser Permanente Commercial	$52.16
Rate for Payer: Kaiser Permanente Medicaid	$29.56
Rate for Payer: Kaiser Permanente Medicare	$52.16
Rate for Payer: MDX Hawaii PPO	$56.22
Rate for Payer: Ohana Health Plan Medicaid	$52.16
Rate for Payer: Ohana Health Plan Medicare	$52.16
Rate for Payer: UnitedHealthcare Medicaid	$34.78
Rate for Payer: UnitedHealthcare Medicare	$52.16
Rate for Payer: University Health Alliance Commercial	$42.25

Know your out-of-pocket cost for care.

All Charges